Retention of a resin-modified glass ionomer adhesive in non-carious cervical lesions. A 6-year follow-up

Do bioactive materials show greater retention rates in restoring permanent teeth than non-bioactive materials? A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

To answer the following research question: does the clinical evaluation of restorations on permanent teeth with bioactive materials show greater retention rates than those with non-bioactive materials?

MATERIALS AND METHODS

A search strategy was used in the following databases: MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Embase, The Cochrane Library, and OpenGrey. Randomized controlled trials (RCTs), with a minimum of 2-year follow-up and evaluating at least one bioactive material in permanent teeth were included. Risk of bias was detected according to the Cochrane Collaboration tool for assessing the risk of bias (RoB 2.0), and network meta-analysis was performed using a random-effects Bayesian-mixed treatment comparison model.

RESULTS

Twenty-seven studies were included. The success of the restorations was assessed using modified USPHS system in 24 studies and the FDI criteria in 3 studies. Network meta-analysis revealed three networks based on restoration preparations. Resin composites were ranked with higher SUCRA values, indicating a greater likelihood of being the preferred treatment for class I, II, and III restorations. In class V, resin-modified glass ionomer cement was ranked with the highest value.

CONCLUSION

Bioactive restorative materials showed similar good clinical performance in terms of retention similarly to conventional resin composites.

CLINICAL SIGNIFICANCE

The findings must be interpreted with caution because many RCT on restorative materials aim to verify the equivalence of new materials over the gold standard material rather than their superiority. The present systematic review also suggests that new RCT with longer follow-up periods are necessary.

Effect of dentin roughening and type of composite material on the restoration of non-carious cervical lesions: an in vivo study with 18 months of follow-up

Objectives

The purpose of this study was to evaluate the impact of dentin roughening and the type of composite resin used (either bulk-fill flowable or nanohybrid) on the restoration of non-carious cervical lesions (NCCLs) with an 18-month follow-up period.

Materials and Methods

This prospective split-mouth study included 36 patients, each with a minimum of 4 NCCLs. For each patient, 4 types of restorations were performed: unroughened dentin with nanohybrid composite, unroughened dentin with bulk-fill flowable composite, roughened dentin with nanohybrid composite, and roughened dentin with bulk-fill flowable composite. A universal bonding agent (Tetric N Bond Universal) was applied in self-etch mode for all groups. The restorations were subsequently evaluated at 6, 12, and 18 months in accordance with the criteria set by the FDI World Dental Federation. Inferential statistics were computed using the Friedman test, with the level of statistical significance established at 0.05.

Results

The 4 groups exhibited no significant differences in relation to fracture and retention, marginal staining, marginal adaptation, postoperative hypersensitivity, or the recurrence of caries at any follow-up point.

Conclusions

Within the limitations of the present study, over an 18-month follow-up period, no significant difference was present in the clinical performance of bulk-fill flowable and nanohybrid composite restorations of non-carious cervical lesions. This held true regardless of whether dentin roughening was performed.

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

OBJECTIVE

To investigate the effectiveness of glass ionomer cement (GIC) restorations on preventing new caries in primary or permanent dentitions compared with other types of restorations.

DATA

Randomized controlled clinical trials evaluating caries experience increment or caries incidence in patients with GIC restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, were included.

SOURCES

A systematic search of publications in English was conducted in PubMed/Medline, Web of Science, Cochrane, and Scopus databases.

STUDY SELECTION/RESULTS

This review included 10 studies reporting caries preventive effect of GIC restorations and selected 5 studies for meta-analysis. Patients with GIC restorations showed lower caries incidence compared with other restorations in primary and permanent dentition [RR=0.67, 95% CI:0.55-0.82, p<0.0001]. Patients with CGIC restorations showed lower caries incidence compared with amalgam restorations [RR=0.57, 95% CI:0.43-0.76, p=0.0001] and RMGIC restorations [RR=0.70, 95% CI:0.56-0.87, p=0.002], but no statistical difference with composite resin restorations [RR=0.73, 95% CI:0.51-1.04, p=0.08] in primary dentition. Patients with RMGIC restorations showed no statistical differences of caries incidence compared with composite resin restorations in primary and permanent dentition [RR=0.83, 95% CI:0.56-1.22, p=0.33].

CONCLUSIONS

GIC restorations presented a better preventive effect on new caries than other restorations did in primary and permanent dentitions. CGIC restorations presented a better caries preventive effect on new caries than RMGIC and amalgam restorations in primary dentitions did. RMGIC restorations showed similar preventing effect on new caries with composite resin restorations in primary and permanent dentitions.

CLINICAL SIGNIFICANCE

This review affirmed the potential of GIC in preventing new caries development in the dentition.

Fiber reinforcement of a resin modified glass ionomer cement

OBJECTIVES

Understand how discontinuous short glass fibers and braided long fibers can be effectively used to reinforce a resin modified glass ionomer cement (RMGIC) for carious lesion restorations.

METHODS

Two control groups (powder/liquid kit and capsule) were prepared from a light cured RMGIC. Either discontinuous short glass fibers or braided polyethylene fiber ribbons were used as a reinforcement both with and without pre-impregnation with resin. For the former case, the matrix was the powder/liquid kit RMGIC, and for the latter case the matrix was the capsule form. Flexural strength was evaluated by three-point beam bending and fracture toughness was evaluated by the single-edge V-notch beam method. Compressive strength tests were performed on cylindrical samples. Results were compared by analysis of variances and Tukey's post-hoc test. Flexural strength data were analyzed using Weibull statistical analysis.

RESULTS

The short fiber reinforced RMGIC both with and without pre-impregnation showed a significant increase of ∼50% in the mean flexural strength and 160-220% higher fracture toughness compared with the powder/liquid RMGIC control. Reinforcement with continuous braided fibers gave more than a 150% increase in flexural strength, and pre-impregnation of the braided fibers with resin resulted in a significant flexural strength increase of more than 300% relative to the capsule control. However, for the short fiber reinforced RMGIC there was no significant benefit of resin pre-impregnation of the fibers. The Weibull modulus for the flexural strength approximately doubled for the fiber reinforced groups compared to the control groups. Finally, compressive strength was similar for all the groups tested.

SIGNIFICANCE

By using a RMGIC as a matrix, higher flexural strength was achieved compared to reported values for short fiber reinforced GICs. Additionally, the short fibers provided effective toughening of the RMGIC matrix by a fiber bridging mechanism. Finally, continuous braided polyethylene fibers gave much higher flexural strength than discontinuous glass fibers, and their effectiveness was enhanced by pre-impregnation of the fibers with resin.

Finite Element Analysis in Setting of Fillings of V-Shaped Tooth Defects Made with Glass-Ionomer Cement and Flowable Composite

The aim of the present paper is to investigate the deformation–stress state of fillings of V-shaped tooth defects by finite element analysis (FEA). Two different materials are used—auto-cured resin-reinforced glass-ionomer cement (GIC) and flowable photo-cured composite (FPC). Two materials are placed into the cavity in one portion, as before the application of the composite the cavity walls are covered with a thin adhesive layer. Deformations and equivalent von Mises stresses are evaluated by FEA. Experimental study of micro-leakage is performed. It is established that there is an analogous non-homogeneous distribution of equivalent Von Mises stresses at fillings of V-shaped defects, made with GIC and FPC. Maximum stresses are generated along the boundaries of the filling on the vestibular surface of the tooth and at the bottom of the filling itself. Values of equivalent Von Mises stresses of GIC fillings are higher than that of FPC. Magnitude and character of deformation distribution at GIC and FPC fillings are similar—deformation is maximum along the vestibular surface of the filling and is 0.056 and 0.053 mm, respectively. In FPC fillings, the adhesive layer, located along the cavity/filling boundary, is characterized with greatest strain. The experimental study of micro-leakage has confirmed the adequacy of models used in FEA.

Do Tooth- and Cavity-related Aspects of Noncarious Cervical Lesions Affect the Retention of Resin Composite Restorations in Adults? A Systematic Review and Meta-analysis

PURPOSE

The purpose was to perform a systematic review and meta-analysis based on the following research question: do tooth- and cavity-related aspects of noncarious cervical lesions (NCCLs) affect the retention of composite restorations?

METHODS

Randomized clinical trials (RCTs) that evaluated the retention rate of resin restorations in NCCLs were included for the identification and comparison of their characteristics. The search was conducted in PubMed and adapted for Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions until July 2018. Unpublished and ongoing trial registries were also searched. The Cochrane Collaboration tool was used for assessing risk of bias. The quality of the evidence was graded using the Grading of Recommendations: Assessment, Development and Evaluation. Using the random effects model, a meta-analysis was conducted for each aspect (arch distribution, tooth location, wear facets, dentin sclerosis, shape, size, depth, occluso-gingival distance, and margin location).

RESULTS

We retrieved 6738 articles. After removal of duplicates and nonrelevant articles, 24 RCTs remained. The anterior tooth location favored the retention rates of restoration of NCCLs (relative risk [RR], 1.08; 95% confidence interval [CI], 1.00-1.16). The presence of wear facets is a risk factor for the retention of restorations (RR, 0.91; 95% CI, 0.83-0.99). The evidence was moderate for arch distribution and low or very low for all other factors because of heterogeneity, imprecision, and inconsistency.

CONCLUSION

The tooth location and the presence of wear facets can affect the retention of composite resins in NCCLs.

Composite vs. ionomer vs. mixed restoration of wedge-shaped dental cervical lesions: Marginal quality relative to eccentric occlusal loading

Dental cervical restorations may be impacted by resultants of occlusal loads that may have already contributed to the development of the lesion and should rely on materials' favorable properties to bear the stresses. The marginal quality of cervical restorations made with materials of different moduli of elasticity in essence, isolated, or in combination, was evaluated relative to eccentric occlusal loading. Cervical wedge-shaped cavities, prepared in extracted premolars, were restored with a composite resin (CR), a restorative ionomer (GIC), or the composite in combination with a lining ionomer (Mixed restoration: M). Half of the teeth in each group were subjected to eccentric occlusal loading (eol; 150 N / 10⁶ cycles / 2.5 Hz; CReol / GICeol / Meol, n = 10), and the others were stored in 37 °C distilled water (Control: c; CRc / GICc / Mc, n = 10). A fluorescein-modified adhesive favored delimitation of formed gaps, which were evaluated by confocal laser scanning microscopy regarding their presence, location related to the cavity walls, and width and depth (µm), at a 5% significance level. From a comprehensive perspective, neither the loading nor the materials were significantly associated with the qualitative response variables or exerted any influence over the quantitative variables. More specifically, the use of the different materials was significantly associated with the frequency of gaps exclusively when loading was applied (Chi-square test, p = 0.029, CR > M > GIC). Though the marginal quality of cervical restorations may not be influenced by eccentric occlusal loading or the use of different materials, even in association in general, the unfavorable aspects of the use of the composite may be relevant, particularly in face of the existence of eccentric occlusal loads.

Remineralization of Natural Human Carious Dentin Lesions with an Experimental Whisker-Reinforced Atraumatic Restorative Treatment Composite

PURPOSE

To evaluate the remineralization of natural human dentin caries with an experimental whisker-reinforced Atraumatic Restorative Treatment (ART) composite.

MATERIALS AND METHODS

Teeth with moderate active dentin caries were prepared with caries-disclosing dye and hand instruments, restored with ART or resin-modified glass ionomer cement (RM-GIC), and then wet sliced into 120-µm sections with 15 sections in each group. After taking transverse microradiographs and implementing digital image analysis to determine the "mineral-loss-before," each section was incubated in artificial saliva solution (pH = 7.0) for 4 weeks and 8 weeks with 1 hour each workday in demineralization solution (pH = 4.3). Transverse microradiographs of each section were retaken, and the "mineral-loss-after" was determined. The remineralization was calculated from [1-("mineral-loss-after"/"mineral-loss-before")] × 100%. Results were statistically analyzed with a repeated-measures ANOVA with one within-subject factor (time: 4 and 8 weeks) and one between-subject factor (material: ART and RM-GIC) (α = 0.05).

RESULTS

The statistical analysis indicated that ART composite resulted in significantly higher remineralization than the RM-GIC (p ≤ 0.05). For the remineralization of each material, there was a statistical difference between 4 weeks and 8 weeks (p ≤ 0.05).

CONCLUSIONS

This experimental ART composite remineralized natural human dentin caries better than the RM-GIC.

Seven-year clinical performance of resin composite versus resin-modified glass ionomer restorations in noncarious cervical lesions

PURPOSE

The purpose of this study was to comparatively assess the seven-year clinical performance of a one-bottle etch-and-rinse adhesive with resin composite (RC) and resin-modified glass ionomer (RMGI) restorations in noncarious cervical lesions.

METHODS AND MATERIALS

One operator placed 70 restorations (35 restorations in each group) in 30 patients under rubber dam isolation without mechanical preparation. The restorations were directly assessed by two independent examiners, using modified US Public Health Service criteria at baseline and 6, 12, 24, 60, and 84 months. The obtained data were tabulated and statistically analyzed using the Fisher and McNemar tests. A difference was significant if p<0.05.

RESULTS

Twenty patients were available for recall after seven years (66.6%), and 25 RC and 26 RMGI restorations out of 70 restorations were evaluated. Excellent agreement was registered for all criteria between examiners (κ≥0.85). Alfa and bravo scores were classified as clinically acceptable. The McNemar test detected significant differences within RC restorations between baseline and seven-year evaluations for anatomic form, marginal integrity, and retention (p<0.05). For RMGI restorations, a significant difference was identified for marginal integrity (p<0.05). As to material comparison, the Fisher exact showed a better retention performance for RMGI restorations than for RC restorations (p<0.05). Twelve composite restorations were dislodged (52.0% retention) and three ionomer restorations were lost (88.5% retention). The cumulative success rate for RC and RMGI was 30% and 58.1%, respectively.

CONCLUSIONS

After seven years of service, the clinical performance of RMGI restorations was superior to that of the adhesive system/resin composite restorations in this study.

Retention of tooth-colored restorations in non-carious cervical lesions--a systematic review

OBJECTIVES

The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs).

METHODS

Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013.

RESULTS

Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed.

CONCLUSION

The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.

Noncarious Cervical Lesions Restored with Three Different Tooth-Colored Materials: Two-Year Results

Introduction:

The aim of this two-year prospective clinical study was to evaluate and compare the clinical performance of three different adhesive esthetic materials in noncarious cervical lesions.

Material and Methods:

A total of 90 restorations (30 per material) were placed in 30 patients who ranged in age between 18 and 50 years and of both genders, by a single operator with no previous preparation. The restoration of noncarious cervical lesions was done with either a microfilled composite (Esthet.X/Dentsply/De Trey, Konstanz, Germany, and Prime&Bond NT/Dentsply/De Trey), a nanohybrid composite (TetricEvoCeram/Vivadent, Schaan, Liechtenstein, and AdheSE/Vivadent), or a compomer (Dyract eXtra/Dentsply/De Trey and Xeno III Dentsply/De Trey). All restorations were evaluated by independent examiners using a modified US Public Health Service criteria at baseline and after 12 and 24 months for six clinical categories. Data were analyzed statistically by Pearson's chi-square or the Fisher's exact test at 5% significance level (p&lt;0.05).

Results:

Results showed that most of the restorations were clinically satisfactory after 12 and 24 months, with no statistically significant differences among the three groups for all evaluated criteria.

Conclusion:

Treatment of noncarious cervical lesions using composite and compomer materials, combined with the appropriate adhesive systems and properly implemented restorative procedures, gives satisfactory results after a two-year evaluation period.

[One-year clinical evaluation of tooth-coloured materials in non-carious cervical lesions]

INTRODUCTION

The restoration of non-carious cervical lesions is specific, mostly because of the location of their margins, especially the cervical margin, which is determined in cement and/or dentine. This feature makes the cervical margin more susceptible to micro-leakage, causing marginal discoloration, postoperative sensitivity, development of the secondary caries and loss of the restoration.

MATERIAL AND METHODS

One of the criteria for inclusion of a patient in this study was the presence of at least two non-carious cervical lesions to be restored with the minimum depth of 1 mm, independently of their location in the dental arch. A total of 60 restorations were placed in 30 patients. and every patient received both tested materials (composite resins and compomer) on their non-carious cervical lesions. The clinical evaluation of the therapeutic success was performed six months and then one year after the day of the placement of restorations using the modified-United States Public Health Service criteria. The following was evaluated retention, marginal integrity, marginal discoloration, wear, postoperative sensitivity and secondary caries.

RESULTS

A statistically significant high percent of restorations/teeth with postoperative sensitivity was found in the group of resin composite restorations after six months. At the end of the evaluation period, that is after one year, there were no statistically significant differences between materials for all evaluated criteria.

CONCLUSION

The results of this study show the identical quality of both examined materials one year after the readjustment of non-carious cervical lesions.

Glass ionomer cements and their role in the restoration of non-carious cervical lesions

Glass ionomer based materials are clinically popular in several areas of restorative dentistry, but restoration of cervical lesions has proven particularly successful. Various etiologies, conformations, locations and structural characteristics make non-carious cervical lesions more challenging to adhesive restorative procedures and marginal seal in the long run. Due to their characteristics, glass ionomer cements (GICs) have precise indication for these cases. Moreover, the use of a GIC base underneath composite resin, the so-called "sandwich" or mixed technique, allows associating the good characteristics of composite resins and GICs, and has been considered quite useful in the restoration of non-carious cervical defects. The aim of this paper is to critically review the literature and discuss peculiar features of GICs regarding their role in the restoration of non-carious cervical lesions.

Two-year clinical evaluation of resinous restorative systems in non-carious cervical lesions

This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch-and-rinse adhesive and resin composite system (Excite/Tetric Ceram) compared to a resin-modified glass ionomer cement (RMGIC) (Vitremer/3M) in non-carious cervical lesions. Seventy cervical restorations (35 resin composite - RC- restorations and 35 RMGIC restorations) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation. All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline, and after 6, 12 and 24 months. Data were analyzed statistically by Fisher's exact and McNemar tests. After 2 years, 59 out of 70 restorations were evaluated. As much as 78.8% retention rate was recorded for RC restorations, while 100% retention was obtained for RMGIC restorations. Fisher's exact test showed significant differences (p=0.011) for retention. However, there were no significant differences for marginal integrity, marginal discoloration, anatomic form and secondary caries between the RC and RMGIC restorations. The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention (p=0.02), marginal integrity (p=0.002) and anatomic form (p=0.04). Therefore, the one-bottle etch-and-rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC.

Rehabilitation of the worn dentition

The purpose of this review was to evaluate the literature on the rehabilitation of tooth wear, with some pertinent historical, epidemiological and aetiological aspects of tooth wear provided as background information. In historical skull material, extensive tooth wear, assumed to be the result of coarser diets, was found even in relatively young individuals. Such wear is seldom seen in current populations. Although many of the factors associated with extensive tooth wear in historical material are no longer present or prevalent, new risk factors have emerged. In the young individual, the literature points to a global rise in soft drink consumption as the most significant factor in the development of tooth wear through dental erosion. Among older individuals, lifestyle changes and chronic diseases that are controlled with medications that may, in turn, result in regurgitation and/or dry mouth, are possible reasons amongst others for the widespread clinical impression of an increasing prevalence of tooth wear. The aetiology of tooth wear is multifactorial and the role of bruxism is not known. Clinical controlled trials of restorative and prosthodontic approaches for the range of clinical conditions that wear can give rise to, are limited in number and quality. Equally, the striking lack of evidence regarding the long-term outcomes of treatment methods and materials calls for caution in clinical decision-making. Notwithstanding these observations, clinicians have provided and continue to provide rehabilitative strategies for managing their patients' worn dentitions that range traditionally from extensive prosthodontics to an increasing reliance on adhesive techniques.

The Effect of Subject Age on the Microtensile Bond Strengths of a Resin and a Resin-modified Glass Ionomer Adhesive to Tooth Structure

For the materials tested, there was no difference in adhesion to young and aged tooth structure.

Long-term dentin retention of etch-and-rinse and self-etch adhesives and a resin-modified glass ionomer cement in non-carious cervical lesions

OBJECTIVES

The aim of this study was to evaluate the clinical long-term retention to dentin of seven adhesive systems.

METHODS

A total of 270 Class V restorations of four etch-and-rinse, one self-etch adhesive system and a resin-modified glass ionomer cement were placed in non-carious cervical lesions without intentional enamel involvement. The restorations were evaluated at baseline, 6, 12, 18, and 24 months and then every year during a 13-year follow-up. Dentin bonding efficiency was determined by the percentage of lost restorations.

RESULTS

During the 13 years, 215 restorations could be evaluated. The cumulative loss rate at 13 years was 53.0%, with significant different failures rates for the different systems varying between 35.6 and 86.8%. Four systems fulfilled the ADA 18-month full acceptance retention criteria. Two systems showed at 18 months and earlier high debonding rates. The annual failure rates for the etch-and-rinse systems were Optibond 3.1%, Permagen 13.0%, Scotchbond MP 4.8%, Syntac classic 2.8%; for the self-etch system P&S 4.4%; and the resin-modified glass ionomer cement Vitremer 2.7%.

CONCLUSION

It can be concluded that all systems showed a continuous degradation of the bond with a wide variation, which was independent of the adhesion strategy. Three bonding systems showed a cumulative failure rate after 13 years between 36 and 41% with the best retention for the resin-modified glass ionomer cement and a four-step etch-and-rinse system.

Clinical evaluation of a polyacid-modified resin composite (Dyract) in class V carious lesions: 5-year results

This study evaluated the 5-year clinical performance of polyacid-modified resin composite, Dyract (DeTrey/Dentsply, Konstanz, Germany), restorations in class V carious lesions. Ninety-two class V carious lesions in 28 patients were restored with Dyract. Restorations were clinically evaluated at baseline, 1-, 2-, 3-, 4-, and 5-year recalls and were evaluated according to the modified Ryge criteria by two experienced calibrated examiners in regard to color match, marginal discoloration, wear or loss of anatomical form, caries, marginal adaptation, and surface texture. The retention rate after 5 years compared to baseline in class V carious restorations was 84%, with only 12 restorations failing. Color change and marginal discoloration in restorations were found to be statistically significant (p = 0.0238 and p < 0.0001, respectively) at the end of the 5 years, but did not require replacement of any of the restorations. The results of this study revealed that at the end of 5 years, Dyract exhibited a clinically acceptable success rate but had significant color changes and marginal discoloration in class V carious lesions.